Cost-utility analysis of medication review with follow-up for cardiovascular outcomes: A microsimulation model

• Published in: Health policy (Amsterdam) Vol. 125; no. 11; pp. 1406 - 1414
• Main Authors: Ahumada-Canale, Antonio, Vargas, Constanza, Martinez-Mardones, Francisco, Plaza-Plaza, José Cristian, Benrimoj, Shalom, Garcia-Cardenas, Victoria
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-11-2021; Elsevier Science Ltd
• Subjects: Aged; Cardiovascular diseases; Cardiovascular system; Clinical outcomes; Clinical trials; Cost analysis; Cost-Benefit Analysis; Cost-effectiveness; Disease; Drug Monitoring; Drugs; Economics; Follow-Up Studies; Health care; Health care expenditures; Humans; Intervention; Medication Review; Outpatients; Pharmacists; Pharmacy; Primary care; Quality-Adjusted Life Years; Uncertainty; Utility functions; Cardiovascular system; Economics; Aged; Drug Monitoring; Cost-effectiveness; Pharmacy
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2021.09.004

•Cardiovascular diseases are the leading cause of death worldwide.•Pharmacist-led medication review might prevent cardiovascular diseases.•An economic evaluation was conducted in the Chilean public primary health care.•The intervention was deemed as a cost-effective addition to usual care at low uncertainty.•Policymakers should consider MRF implementation in the local setting.
Cardiovascular diseases are the leading cause of death. Pharmacist-led medication review with follow-up might be cost-effective preventing cardiovascular diseases.
To undertake a cost–utility analysis of the addition of pharmacist-led medication review with follow-up to usual care compared to usual care alone for cardiovascular outpatients.
A state-transition microsimulation model was built to project outcomes over a lifetime time horizon. Inputs from a cluster randomized controlled trial conducted in primary health care centers in Chile with full-time pharmacists were used. Probabilities were estimated using patient-level data. Utilities and costs associated with each health state were obtained from the literature, whereas the intervention costs were retrieved from the trial. The public third-party payer perspective was used. Uncertainty was evaluated through one-way and probabilistic sensitivity analyses.
For the base case analysis, an incremental cost-effectiveness ratio of $963 per quality-adjusted life-year was observed which was considered cost-effective. The results were robust to sensitivity analyses and were driven by decreased cardiovascular events resulting in lower mortality.
Medication review with follow-up was deemed a cost-effective addition to usual care with low uncertainty.